Front Burner - Vaping sickness: what we know and what we don't

Episode Date: September 24, 2019

A young man in London, Ont., was recently put on life-support with a respiratory illness that's been linked to vaping. He was the first with that diagnosis in Canada, after more than 450 Americans fell ill, and eight died, also from vaping-linked respiratory illnesses. How much do we actually know about the health impacts of vaping nicotine or marijuana? Andre Picard is the health reporter for the Globe and Mail. He says the jury is still out. "Smoking is like jumping off the hundredth floor of a building," says Picard. "Vaping is like jumping out, we just don't know which floor yet."

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. Do you have questions about vaping? Because I have a lot of questions about vaping. And I guess that's not too surprising.

I mean, it's huge. According to the University of Waterloo, half a million Canadians have tried an e-cigarette. And then there are all these reports now of people getting sick. A Canadian in London, Ontario, who ended up on life support. So the individual was using e-cigarettes at least daily. And hundreds of cases in the United States, 530 people now, including eight deaths from vape-related factors. They had no idea what was going on inside until they put me into the medically induced coma. I'm 18 years old. My lungs are like a seven, eight-year-old's. So what's causing this and why now? I mean, wasn't this supposed to be safer than smoking?

Today, we're going to try and get as clear a picture as possible about vaping. I'm joined by Andre Picard, health reporter for The Globe and Mail. This is FrontBurner. Andre, thank you so much for joining me today. Hi. So I'm a bit confused by what's going on here. What is actually making all these people sick? And I think that I need to start at the beginning to really understand this. And so, you know, maybe some people listening have tried vaping. I think most of us have probably seen people puffing on what looks like a USB stick.

But can you explain to me the logistics of how vaping actually works? Yeah. So cigarettes, as you know, so smoking is lighting tobacco, so combustible product, and then breathing in smoke. Vaping is heating up a liquid with a coil, usually battery operated, and that produces a vapor, which you inhale. So the difference is between smoking and vaping is smoke versus vapor. Each of these things have chemicals in them. Smoke has a whole bunch of chemicals, Vapor has a little less. And usually with vaping, they add things like flavors. And those are a big issue of debate now. Okay. And I want to get to that in a moment. But, you know, when we say vaping,

we're not just talking about nicotine through this liquid, right? Like this vape juice or e-juice. We're also talking about vaping weed. And that can be done in an oil or like just by stuffing a bunch of weed into a vaping device. Am I right about that? Yeah, you could put any number of substances in the liquid. So the issue is heat the liquid to create vapor and it can be nicotine, it can be watermelon flavor, it can be THC, it can be Dab, it can be any number of things. And Dab is like a really concentrated form of THC, right? Yeah. Okay. How popular is vaping right now?

Because we're hearing all these stories from teachers who say that they have teens in their classes who are like essentially smoking these e-cigarettes under their t-shirts in class. And do people do it right in the school? Yeah, for sure. Where? Washrooms, outside, in class if they can get away with it. Just when the teacher's not looking, and then just blow it in their shirt. Yeah, if the teacher leaves the room, a vape will come out sometimes.

Yeah, it is common. It does happen, yeah. Yeah, so it is very popular with teens. About roughly 1 in 5 high school students vape, so 20%, quite high. About 1 in 20 adults vape. So it's fairly popular. Okay. And I know one kind of staggering statistic that I read recently was that this company, Juul, which makes the cigarettes and the pods that you put in them, like a very popular company, they're going to make more than $3.4 billion in sales this year. Yeah. Juul is immensely popular, especially with the young people because they

look like a USB key. So it's really easy to hide, low maintenance, etc. And one pod is the equivalent of the nicotine in a pack of cigarettes, about 200 puffs. So you can really, you get addicted quickly. That's the problem with that product. Okay, okay. University of Waterloo professor David Hammond studies the public health implications of vaping. If you're worried about your kids vaping, this is probably your nightmare product. This generally has two or three times the nicotine concentration of other e-cigarettes. It's so high, in fact, that they couldn't sell this version in England, where they have limits on the nicotine content. And these statistics that we're talking about,

are they generally statistics around e-cigarettes, like the nicotine e-cigarettes, or are we also talking about vaping weed or THC oil here? Do we know how popular that is? We don't really know because, you know, in most U.S. states, it's not like Canada, so it's illegal. So people are reluctant to talk about it. Statistics are complicated to weed through. Okay. So we know essentially these are enormously popular, particularly among young people, though it's a little bit unclear, you know, how many people are using it for e-cigarettes and how many people are using it for vaping weed, but nonetheless, very popular. I want to talk to you about these vape-related illnesses that we started seeing. I understand, like for me, watching

the news, this all started happening over the summer. This is when we really started to see them. Federal and state investigators are trying to get to the bottom of a recent outbreak of lung illnesses that could be linked to vaping. Symptoms include coughing, shortness of breath and fever. You know, these things are increasing and every day we're hearing more and more about it. And tell me about what was happening. Well, the first reports came out in the summer. So I think it's an issue of quantity. So if you have enough people doing something, you start to see trends.

So the same thing when smoking started, we didn't realize it would make people sick until there was enough of a critical mass that you start seeing consequences. And that's true of any product. With vaping, these illnesses have probably occurred earlier, but we're just seeing them and people are spotting patterns now. And the pattern that seems to be emerging is young people, almost all young men, vaping THC, so a cannabis product, and then buying it on the black market. So that's a big issue. So the issue seems to be bootleg products, some kind of adulterated substance in the vaping liquid that's causing them to be ill. And that's what the doctors think is making them ill, the vaping of THC or doctor THC.

Oil? Is that what we're talking about? It could be oil. You shouldn't be vaping oil. So if there's oil in your product, it's probably a bootleg product. It's probably not a good thing to start off with. So that's problematic. But the outcome is this fairly rare form of pneumonia. So pneumonia, what pneumonia means is your lungs filling up with liquid. And in this case, what they're seeing in these young people is not only liquid, but globules of fat.

And that indicates that there's some kind of product in there that shouldn't be. So initially, we talked about vitamin E acetate. So something that's used commonly in vitamins, but you shouldn't have it in your lungs. So they said this in a few young people, but we've been cautioned that this isn't in everyone. So that's probably not the source, but as an example of there's some kind of chemical reaction going on that's causing, it seems, this rare form of pneumonia. form of pneumonia. I mean, you mentioned before vaping sort of THC, THC oil. My understanding is we also have this recent case from London, Ontario, where a young person in high school

suffered sort of severe pulmonary illness. So this pneumonia that you're talking about, he was on life support for a little while. After treatment and examinations from Middlesex County doctors, all signs pointed to one cause. No other immune-related issues. The only issue that was identified was that the individual was vaping e-cigarettes. But apparently he didn't use cannabis oil, but was a fairly heavy vaper of nicotine-based products. Are people getting sick from the nicotine-based products as well? Yes. There's been one good study published so far in the U.S., a fairly small study, but it had good data. So the data, 84% of the people who got sick vaping THC, but 61% of them were also vaping nicotine.

So we don't know, is the short answer. The Canadian case in Canada, we're a bit obsessive about privacy. So we don't really know a lot of detail. We're told that he didn't vape THC, but young people don't always admit this either. My understanding is e-cigarettes have been around since the mid-2000s. So why are we seeing all of these illnesses now manifest? Well, again, it's a question of critical mass. So yeah, they've been around more than a decade, but the numbers are really picking up. And when you have large numbers, you have patterns. So it's

the same with any drug scandal that emerges. It always takes time and to have a large number of people before you can spot patterns. It's probably some people got sick ten years ago but you have this large number and we're able to spot them now. Don't forget most people who vape, especially initially, were heavy smokers. So if you have a lung disease that's because of your years of smoking, it's not the vaping. So there's all kinds of complicating factors in here. And the other one is this market has become so so profitable that there's a lot of bootleg stuff. So vaping can be not as expensive as smoking, but it can

be expensive. So people turn to the internet and they buy products that are maybe dubious quality. But it's possible that people are also getting sick, not from bootleg products, right? Right. It's quite possible. We just, we don't know. products, right? Right. It's quite possible. We just, we don't know. Okay. I often hear the term popcorn lung when people are talking about vaping. And is that what we're talking about here? This isn't popcorn lung. Popcorn lung is something they talked about for a long time when vaping was coming in, a warning that, you know, if you breathe in chemicals, this is going to happen to you. A new study by Harvard University reports more than 75 percent of flavored e-cigarettes contain diacetyl and the chemical has been linked to the respiratory

disease. And that's a phenomenon that happens around factories. The condition first appeared in workers who inhaled artificial butter flavoring from microwave popcorn. This isn't exactly that but it's sort of a it's the warning that public health people were making five and ten years ago that bad stuff is going to happen when you put chemicals in your body. Okay, okay. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem.

Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. In the United States, Donald Trump has now announced a ban for the flavored e-cigarettes, which I imagine is something that companies use to market to young people. Vaping has become a very big business, as I understand it, like a giant business in a very short period of time. But we can't allow people to get sick, and we can't have our youth be so affected. Do you think that this is a good plan? Is this the answer? Well, you know, the whole issue of banning things, I'm not a big fan of. Prohibition never works,

regardless of the substance. History tells us it never works. So the issue is how do you regulate? We have to remember that vaping is technically illegal for all these young people who are getting sick. So the regulation is not working now. Right, because they're under the age of legally being allowed to be. Yeah, 18 or 19, depending on the jurisdiction. So this is all the illegal stuff. So you make it more illegal, will it change things? Probably not. It'll push them more to the black market and probably even more dubious products. So that's probably not the solution. Now, should we regulate flavors? Probably. It's probably a good idea. Clearly, they're meant to attract young people.

Companies like Juul, I think they've already withdrawn a whole number of flavors, largely because of lawsuits. Four e-cigarette flavors that experts say attract kids. Mango, cucumber, cream and fruit. And we'll sell them online only. So the issue is, will that stop kids from being attracted to this or are they addicted to nicotine and the flavor is just something else and like many questions regarding vaping we just don't have any idea. A coalition of Canadian health groups is demanding Ottawa take urgent action on e-cigarettes.

Doctors say they've seen enough. It's time to treat vaping like smoking. Ban the ads, get rid of flavors, limit nicotine levels, and slap on the health warnings. Youth vaping has become a public health crisis. And we need action now. Another thing I wanted to talk to you about is the trade-off here, because the argument you see in ads for vape shops and companies is that vaping is actually safer than traditional cigarettes, and that it's easier on your lungs.

The switch was easy. It was a no-brainer, really. But now that I look at people who smoke, I'm like, dude, really? You still doing that? You know there's an alternative to that, right? You don't have to do that. And so is that true? Do they have a point here? Even though we are seeing all these people getting sick from this.

Well, this is a point of a lot of debate. So this is a huge debate in the public health field. I think there's no question that smoking is the worst thing possible. So breathing in articles of combustion is bad. We know that. We've known that for many, many years, whether it's from barbecues or forest fires or cigarettes. Combustibles are really bad for your lungs. So we know that. Vapor, less harmful. It's just essentially heat. So in theory, vaping should be far less dangerous and harmful than smoking. The complication comes in when you start adding things. So you start adding a flavor.

Well, what are the chemicals in that? When you combust, chemicals change when you heat them up. Is that what's causing it? You put in things like acetate. Maybe that's going to cause you really in things like acetate, maybe that's going to cause you really serious problems. So it's, again, none of these issues are simple, but on the surface, I think the message that has to be delivered is if you smoke, then vaping is going to be a better alternative. But if you don't smoke or you don't vape,

you shouldn't start vaping. And does this same argument hold for marijuana? Like, is it easier on your lungs than smoking a joint? Yeah, it's exactly same argument is that if you avoid the products of combustion, if you have steam instead of smoke, that's going to be less harmful. So yeah, that applies to anything, THC, nicotine. You know, you can theoretically just vape flavored water, but nobody does that. Right. But I have never heard of anybody going to a hospital with acute respiratory illness from smoking too many joints. Right. And we've not heard of people going to hospital for acute respiratory illness for cigarettes. But that doesn't mean they're good for you. I think this acute issue is about an adulterant. So the issue is dealing with the adulterant.

I think we're paying a little too much attention to the acute and not enough to the long-term consequences. And, you know, why are teens drawn to vaping? That's the issue that fascinates me. I think no one predicted this. Vaping was marketed as it's this alternative to cigarettes, we're going to get these smokers and we're going to get them hooked on our product instead. Who would have guessed that teens would be attracted to a bunch of steam coming out of

their mouth? Nobody. I don't know. You know, in a way I can totally see it, especially when you add like watermelon flavor to it. I mean, these are, one, you know, nicotine isn't of itself addictive. And two, these things look cool. They look like futuristic cigarettes. And if it's just steam, does it matter? So the issue is we've learned that, well, it's not just steam, something else in there. Maybe the flavors themselves are problematic. So we have to address these issues as they arise. Right. And you're saying that there needs to be a focus on the combination of things that are in these right now and what may be causing these acute illnesses. But, you know, I am struck by

the fact that the scientific community has still been saying for years now that we don't have the research to know definitively what the effects of vaping are. You mentioned this as well, particularly because we're adding all of this stuff to these vape pens like flavours or other kind of chemicals. But come mid-December, it's going to be legal to sell cannabis oils for vaping. Edibles will gradually hit store shelves. The new government regulations require all products to have extensive warning labels. Similar standards will also be put in place for cannabis extracts and topicals. Given the lack of long-term science on this and the uncertainty about its long-term effects,

I'm wondering why Health Canada greenlit this for sale. Well, I think it's the philosophy of legalization is the philosophy of harm reduction. So the reality is people are going to smoke, they're going to vape. And how do we, I believe the role of public health and of regulators is to inform people and make it less harmful. People are going to do all kinds of harmful stuff. They drink, they smoke, they drive too fast. And the job of public health is, you know, how do you lessen the risk of hurting themselves? I take your point, but if I could push back on it for a moment. We started this conversation, you were talking about how popular these have become for teenagers, right? And I have to wonder

if they didn't exist, if we never created them, or like they were never sort of widely available, would teenagers have smoked instead? You know, it seems to me that in this day and age, there's so much education around smoking that young people actually aren't taking it up. Like we're actually not giving them this option to do something better than smoking because they probably wouldn't have taken that up in the first place. Well, a surprising number of teens still smoke.

It's gone steadily down over the years, but the last numbers are pretty stubborn. You know, we have this notion of kids are anti-smoking. They are, but a fair number smoke, almost as many as vape, to be honest. So the question is, the big question with teens is, if they get hooked on nicotine from vaping, will they turn to cigarettes when they're more available or cheaper or whatever? So we don't know that.

There's some evidence, again, it depends how you read on the statistics, slight evidence, a little bit of an optic in smoking. People immediately blame that on vaping. But if you look at the data, it goes up and down a little bit over the years. It's almost within the margin of error. Again, I don't think we know the impact of vaping on smoking. Last year you wrote a column saying concern about e-cigarettes was hysteria. That's the word that you used in that column. Do you still feel that way?

Do you feel like we're seeing a hysteria right now? Yes. Huh. How come? Yeah. So eight deaths from vaping, true. 480,000 smoking deaths a year in the U.S. So it's a question of proportion. You know, let's keep our focus on what's really killing people. I'm not saying, I've never said that, you know, we should encourage teens to vape. I saw an analogy recently, which I love, which is that smoking is like jumping off the hundredth floor of a building. Vaping is like jumping out another floor of the building. We just don't know what floor yet. Right. So that's, I think, the message we have to get to teens. Yeah, this is fun. You know, it gives you a good buzz, But long term, you're not going to feel very good. It's going to cost you money.

So the same arguments we've made about smoking, we have to make them about vaping. You can't scare teenagers into good health. You have to just try and reason with them and be patient and try and give them the information to cause themselves less harm. I know you've made this point several times in this conversation that vaping is still safer than smoking. But I am wondering, you know, since we don't have this long term scientific data on this, is there a scenario in which, you know, five or 10 years from now, we could potentially find out that it's actually like jumping off the 200th floor of a building? I suppose both of them would be very dangerous and would probably kill you. But you know what I mean?

Like, is it possible that it's going to be more dangerous than smoking? Because we just didn't know at the time the effects of mixing these chemicals and vaporizing them. Yeah, of course it's possible. You know, a lot of people say maybe it's the new smoking. When smoking came in, no one worried about it. It was, great it's cool you lose weight etc and over time we saw you know the consequences are long term so with vaping we've had this acute illness which is worrisome but small the bigger worry is what is the long-term impact and we don't know but i think we have to at this point operate on the information we have.

And the information we have is no question that smoke is more dangerous than steam or vapor. So I think we have to operate on that knowledge now and adjust it if it changes over time. Okay. Andre Picard, thank you so much for this conversation. You answered a lot of the questions that I had about this issue.

I really appreciate it. Thank you. So just a note to say that Health Canada sent us a statement for this story. They said the government of Canada is concerned by the reports of vaping-related illnesses, as well as the increase in vaping by Canadian youth. And they say they're working with their U.S. counterparts as well as provinces and territories. In other news, a quick recap of Monday on the federal election campaign trail. The Liberals and the NDP focused Monday on making drugs more affordable for you. Making sure that no Canadian ever has to choose between paying for groceries and paying for medication. Seniors could go into the pharmacy

and use their health card, not their credit card. We're talking about a national pharmacare plan here. We did an episode on this. You can find it in our feed. Though the liberals were criticized for a lack of details, most notably how much this is all going to cost. Meanwhile, Andrew Scheer took aim at home ownership. He vowed to review the so-called stress test or financial bar that first-time homebuyers have to meet. He says it's having an unintended consequence of making it too hard for people to get a mortgage. And because his latest initiative has so many hoops to jump through, so many terms and conditions, you and almost all the Canadians it's supposed to help don't even qualify. He also said a conservative government would allow people to take out a 30

year mortgage. 25 years is currently the limit. So this is an attempt to get those monthly payments down. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and see you all tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.